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1.
J Water Health ; 18(6): 1009-1019, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33328371

RESUMO

Disinfecting surfaces with chlorine is commonly conducted in cholera outbreaks to prevent ongoing fomite-based transmission, yet evidence gaps have led to contradictory guidance. In this study, we tested the efficacy of spraying and wiping chlorine on five representatives non-porous and five porous surfaces to remove Vibrio cholerae. In total, 120 disinfection tests were run in replicate on carriers inoculated with 1.02 × 107-1.73 × 108 V. cholerae CFU/cm2. Surfaces disinfected by spraying 0.2% chlorine had >3 log reduction value (LRV) on 7/10 and 9/10 surfaces at 1 and 10 min, respectively; and 2.0% chlorine on 9/10 and 10/10 surfaces at 1 and 10 min, respectively. Surfaces disinfected by wiping 0.2% chlorine had >3 LRV on 3/10 and 7/10 surfaces at 1 and 10 min, respectively; and 2.0% chlorine on 8/10 surfaces at 1 and 10 min. We found no significant differences between chlorine types (p < 0.05), higher reductions with spraying compared to wiping (p = 0.001), and lower reductions on porous compared to non-porous surfaces (p = 0.006 spraying and p < 0.001 wiping). Our results support using 0.2% chlorine sprayed on all surfaces, or wiped on most non-heavily soiled surfaces, and a 2.0% concentration on contaminated porous surfaces; and emphasize surfaces must be visibly wetted to achieve disinfection.


Assuntos
Cólera , Desinfetantes , Vibrio cholerae , Cloro/farmacologia , Desinfetantes/farmacologia , Desinfecção , Humanos , Laboratórios
2.
Vaccimonitor (La Habana, Print) ; 29(3)sept.-dic. 2020. graf
Artigo em Inglês | LILACS, CUMED | ID: biblio-1139857

RESUMO

Cholera is endemic in over 50 countries with an estimated mortality of 100,000-120,000. Vaccination is considered the complementary key to prevent and control cholera; therefore, alternative vaccine preparations are needed. Toxin Co-regulated Pilus is part of the toxR virulence regulon, which is necessary for colonization in the intestinal mucosa. In order to express Vibrio cholerae TcpA protein in Saccharomyces boulardii, the expression plasmid pYES2 was constructed by inserting tcpA gene isolated from local Vibrio cholerae Eltor Inaba isolates. The new construct was transferred into Saccharomyces boulardii cells and the expression of tcpA gene was induced from the GAL1 promoter by adding galactose to the medium. The SDS-PAGE and Western blot analysis showed the presence of TcpA in yeast. These results showed that Saccharomyces boulardii is a promising host to express Vibrio cholerae toxin TcpA as the first step in attempt to produce an oral Vibrio cholerae vaccine(AU)


El cólera es endémico en más de 50 países. Se estima una mortalidad entre 100.000 - 120.000 debido a esta enfermedad. La vacunación se considera una medida complementaria para prevenir y controlar el cólera, por lo tanto, se necesitan preparaciones vacunales alternativas a las existentes. El Pili corregulado con la toxina, es parte del regulón de virulencia toxR, y es necesario para la colonización en la mucosa intestinal. Para expresar la proteína tcpA de Vibrio cholerae en Saccharomyces boulardii, se construyó el plásmido de expresión pYES2 insertando el gen tcpA obtenido a partir de aislamientos locales de Vibrio cholerae El Tor Inaba. La nueva construcción se transfirió a las células de Saccharomyces boulardii y se indujo la expresión del gen tcpA a partir del promotor GAL1 mediante la adición de galactosa al medio. El análisis mediante SDS-PAGE y Western blot demostró la presencia de TcpA en levaduras. Los resultados demostraron que Saccharomyces boulardii es un hospedero prometedor para expresar el gen tcpA de Vibrio cholerae como el primer paso en el intento de producir una vacuna oral contra Vibrio cholerae(AU)


Assuntos
Humanos , Vacinas contra Cólera/uso terapêutico , Cólera/mortalidade , Cólera/prevenção & controle , Infecções por Escherichia coli , Saccharomyces boulardii/efeitos dos fármacos
3.
Nat Commun ; 11(1): 5347, 2020 10 22.
Artigo em Inglês | MEDLINE | ID: mdl-33093464

RESUMO

In 1970, the seventh pandemic of cholera (7 P) reached both Africa and Europe. Between 1970 and 2011, several European countries reported cholera outbreaks of a few to more than 2,000 cases. We report here a whole-genome analysis of 1,324 7 P V. cholerae El Tor (7 PET) isolates, including 172 from autochthonous sporadic or outbreak cholera cases occurring between 1970 and 2011 in Europe, providing insight into the spatial and temporal spread of this pathogen across Europe. In this work, we show that the 7 PET lineage was introduced at least eight times into two main regions: Eastern and Southern Europe. Greater recurrence of the disease was observed in Eastern Europe, where it persisted until 2011. It was introduced into this region from Southern Asia, often circulating regionally in the countries bordering the Black Sea, and in the Middle East before reaching Eastern Africa on several occasions. In Southern Europe, the disease was mostly seen in individual countries during the 1970s and was imported from North and West Africa, except in 1994, when cholera was imported into Albania and Italy from the Black Sea region. These results shed light on the geographic course of cholera during the seventh pandemic and highlight the role of humans in its global dissemination.


Assuntos
Cólera/história , Pandemias/história , Cólera/epidemiologia , Cólera/microbiologia , Farmacorresistência Bacteriana/genética , Europa (Continente)/epidemiologia , Evolução Molecular , Genoma Bacteriano , Genômica , História do Século XX , História do Século XXI , Migração Humana/história , Humanos , Filogenia , Ribotipagem , Análise Espaço-Temporal , Vibrio cholerae/classificação , Vibrio cholerae/genética , Vibrio cholerae/isolamento & purificação
4.
BMC Infect Dis ; 20(1): 741, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33036564

RESUMO

BACKGROUND: Cholera remains a major global health challenge. Uvira, in the Democratic Republic of the Congo (DRC), has had endemic cholera since the 1970's and has been implicated as a possible point of origin for national outbreaks. A previous study among this population, reported a case confirmation rate of 40% by rapid diagnostic test (RDT) among patients at the Uvira Cholera Treatment Centre (CTC). This study considers the prevalence and diversity of 15 enteric pathogens in suspected cholera cases seeking treatment at the Uvira CTC. METHODS: We used the Luminex xTAG® multiplex PCR to test for 15 enteric pathogens, including toxigenic strains of V. cholerae in rectal swabs preserved on Whatman FTA Elute cards. Results were interpreted on MAGPIX® and analyzed on the xTAG® Data Analysis Software. Prevalence of enteric pathogens were calculated and pathogen diversity was modelled with a Poisson regression. RESULTS: Among 269 enrolled CTC patients, PCR detected the presence of toxigenic Vibrio cholerae in 38% (103/269) of the patients, which were considered to be cholera cases. These strains were detected as the sole pathogen in 36% (37/103) of these cases. Almost half (45%) of all study participants carried multiple enteric pathogens (two or more). Enterotoxigenic Escherichia coli (36%) and Cryptosporidium (28%) were the other most common pathogens identified amongst all participants. No pathogen was detected in 16.4% of study participants. Mean number of pathogens was highest amongst boys and girls aged 1-15 years and lowest in women aged 16-81 years. Ninety-three percent of toxigenic V. cholerae strains detected by PCR were found in patients having tested positive for V. cholerae O1 by RDT. CONCLUSIONS: Our study supports previous results from DRC and other cholera endemic areas in sub-Sahara Africa with less than half of CTC admissions positive for cholera by PCR. More research is required to determine the causes of severe acute diarrhea in these low-resource, endemic areas to optimize treatment measures. TRIAL REGISTRATION: This study is part of the impact evaluation study entitled: "Impact Evaluation of Urban Water Supply Improvements on Cholera and Other Diarrheal Diseases in Uvira, Democratic Republic of Congo" registered on 10 October 2016 at clinicaltrials.gov Identification number: NCT02928341 .


Assuntos
Cólera/epidemiologia , Criptosporidiose/epidemiologia , Cryptosporidium/genética , Diarreia/epidemiologia , Surtos de Doenças , Escherichia coli Enterotoxigênica/genética , Infecções por Escherichia coli/epidemiologia , Vibrio cholerae/genética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Criança , Pré-Escolar , Cólera/microbiologia , Criptosporidiose/parasitologia , República Democrática do Congo/epidemiologia , Testes Diagnósticos de Rotina , Diarreia/microbiologia , Doenças Endêmicas , Infecções por Escherichia coli/microbiologia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase Multiplex , Prevalência , Microbiologia da Água , Adulto Jovem
5.
Nat Commun ; 11(1): 4918, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33004800

RESUMO

In order to control and eradicate epidemic cholera, we need to understand how epidemics begin, how they spread, and how they decline and eventually end. This requires extensive sampling of epidemic disease over time, alongside the background of endemic disease that may exist concurrently with the epidemic. The unique circumstances surrounding the Argentinian cholera epidemic of 1992-1998 presented an opportunity to do this. Here, we use 490 Argentinian V. cholerae genome sequences to characterise the variation within, and between, epidemic and endemic V. cholerae. We show that, during the 1992-1998 cholera epidemic, the invariant epidemic clone co-existed alongside highly diverse members of the Vibrio cholerae species in Argentina, and we contrast the clonality of epidemic V. cholerae with the background diversity of local endemic bacteria. Our findings refine and add nuance to our genomic definitions of epidemic and endemic cholera, and are of direct relevance to controlling current and future cholera epidemics.


Assuntos
Cólera/microbiologia , Doenças Endêmicas/prevenção & controle , Genoma Bacteriano/genética , Pandemias/prevenção & controle , Vibrio cholerae/genética , Argentina/epidemiologia , Cólera/epidemiologia , Cólera/prevenção & controle , DNA Bacteriano/genética , DNA Bacteriano/isolamento & purificação , História do Século XIX , História do Século XX , Humanos , Anotação de Sequência Molecular , Pandemias/história , Filogenia , Polimorfismo de Nucleotídeo Único , Análise de Sequência de DNA , Vibrio cholerae/isolamento & purificação , Vibrio cholerae/patogenicidade
6.
PLoS One ; 15(9): e0238438, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32881972

RESUMO

Vibrio cholerae is a natural inhabitant of aquatic ecosystems worldwide, typically residing in coastal or brackish water. While more than 200 serogroups have been identified, only serogroups O1 and O139 have been associated with epidemic cholera. However, infections other than cholera can be caused by nonepidemic, non-O1/non-O139 V. cholerae strains, including gastroenteritis and extraintestinal infections. While V. cholerae can also survive in freshwater, that is typically only observed in regions of the world where cholera is endemic. We recently isolated V. cholerae from several locations in lakes and rivers in northwest Ohio. These isolates were all found to be non-O1/non-O139 V. cholerae strains, that would not cause cholera. However, these isolates contained a variety of virulence genes, including ctxA, rtxA, rtxC, hlyA, and ompU. Therefore, it is possible that some of these isolates have the potential to cause gastroenteritis or other infections in humans. We also investigated the relative motility of the isolates and their ability to form biofilms as this is important for V. cholerae survival in the environment. We identified one isolate that forms very robust biofilms, up to 4x that of our laboratory strains. Finally, we investigated the susceptibility of these isolates to a panel of antibiotics. We found that many of the isolates showed decreased susceptibility to some of the antibiotics tested, which could be of concern. While we do not know if these isolates are pathogenic to humans, increased surveillance to better understand the public health risk to the local community should be considered.


Assuntos
Água Doce/microbiologia , Vibrio cholerae/genética , Proteínas de Bactérias/genética , Cólera/epidemiologia , Ecossistema , Humanos , Ohio/epidemiologia , Reação em Cadeia da Polimerase , Vibrio cholerae/isolamento & purificação , Vibrio cholerae/metabolismo , Virulência/genética , Fatores de Virulência/genética , Microbiologia da Água
7.
Arch Iran Med ; 23(8): 578-581, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32894975

RESUMO

In the past two centuries, several fatal infectious outbreaks have arisen in Iran. Presented here is a brief historical account of four fatal epidemics including cholera, plague, Spanish influenza of 1918 and smallpox between1796 and 1979. The lessons from these outbreaks could be helpful for better combatting other deadly epidemics including the present-day disastrous COVID-19 pandemic.


Assuntos
Cólera/história , Controle de Doenças Transmissíveis/história , Epidemias/história , Influenza Pandêmica, 1918-1919/história , Peste/história , Varíola/história , Cólera/epidemiologia , Cólera/prevenção & controle , Epidemias/prevenção & controle , História do Século XIX , História do Século XX , Humanos , Irã (Geográfico)/epidemiologia , Peste/epidemiologia , Peste/prevenção & controle , Varíola/epidemiologia , Varíola/prevenção & controle
8.
PLoS Negl Trop Dis ; 14(8): e0008661, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32866145

RESUMO

Household spraying is a commonly implemented, yet an under-researched, cholera response intervention where a response team sprays surfaces in cholera patients' houses with chlorine. We conducted mixed-methods evaluations of three household spraying programs in the Democratic Republic of Congo and Haiti, including 18 key informant interviews, 14 household surveys and observations, and 418 surface samples collected before spraying, 30 minutes and 24 hours after spraying. The surfaces consistently most contaminated with Vibrio cholerae were food preparation areas, near the patient's bed and the latrine. Effectiveness varied between programs, with statistically significant reductions in V. cholerae concentrations 30 minutes after spraying in two programs. Surface contamination after 24 hours was variable between households and programs. Program challenges included difficulty locating households, transportation and funding limitations, and reaching households quickly after case presentation (disinfection occurred 2-6 days after reported cholera onset). Program advantages included the concurrent deployment of hygiene promotion activities. Further research is indicated on perception, recontamination, cost-effectiveness, viable but nonculturable V. cholerae, and epidemiological coverage. We recommend that, if spraying is implemented, spraying agents should: disinfect surfaces systematically until wet using 0.2/2.0% chlorine solution, including kitchen spaces, patients' beds, and latrines; arrive at households quickly; and, concurrently deploy hygiene promotion activities.


Assuntos
Cólera/epidemiologia , Cólera/prevenção & controle , Desinfecção/métodos , Características da Família , Cloro , Congo/epidemiologia , Surtos de Doenças/prevenção & controle , Feminino , Haiti/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Inquéritos e Questionários , Toaletes , Vibrio cholerae
9.
Postgrad Med J ; 96(1140): 633-638, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32907877

RESUMO

After the dramatic coronavirus outbreak at the end of 2019 in Wuhan, Hubei province, China, on 11 March 2020, a pandemic was declared by the WHO. Most countries worldwide imposed a quarantine or lockdown to their citizens, in an attempt to prevent uncontrolled infection from spreading. Historically, quarantine is the 40-day period of forced isolation to prevent the spread of an infectious disease. In this educational paper, a historical overview from the sacred temples of ancient Greece-the cradle of medicine-to modern hospitals, along with the conceive of healthcare systems, is provided. A few foods for thought as to the conflict between ethics in medicine and shortage of personnel and financial resources in the coronavirus disease 2019 era are offered as well.


Assuntos
Infecções por Coronavirus/epidemiologia , Ética Médica/história , Alocação de Recursos para a Atenção à Saúde/ética , Hospitais/história , Pandemias/história , Pneumonia Viral/epidemiologia , Quarentena/história , Betacoronavirus , Cólera/epidemiologia , Cólera/história , Mão de Obra em Saúde , Juramento Hipocrático , História do Século XV , História do Século XVI , História do Século XVII , História do Século XVIII , História do Século XIX , História do Século XX , História do Século XXI , História Antiga , História Medieval , Humanos , Hanseníase/epidemiologia , Hanseníase/história , Peste/epidemiologia , Peste/história , Alocação de Recursos , Estados Unidos/epidemiologia
10.
Wkly. epidemiol. rec ; 95(37): 441-448, 2020-09-11.
Artigo em Inglês, Francês | WHO IRIS | ID: who-334242

Assuntos
Cólera
11.
Artigo em Inglês | MEDLINE | ID: mdl-32781601

RESUMO

Distribution, investigation, surveillance and control (DISC) of cholera outbreaks in endemic/non-endemic regions has been a concerted approach towards the management of the causal pathogen. Relevant organization, government, health systems and the public have implemented several steps towards controlling the menace, yet pathogen continues to occur with diverse phenotypes/genotypes of high clinical and epidemiological relevance. The study determines antibiotic susceptibility/resistance pattern of Vibrio cholerae isolates retrieved from six domestic water sources between March and August 2018. Serological and molecular typing methods (polymerase chain reaction or PCR) were used to confirm the isolates identity. Antibiotic susceptibility testing was conducted using six commonly employed antibiotics of V. cholerae according to the recommendation of Clinical Laboratory Standard and European Committee for Antimicrobial Susceptibility Testing with other relevant antibiotics of investigative epidemiology and infection control, employing both disc diffusion test and PCR gene detection. Samples presumptive counts ranged between 1.10 to 7.91 log10 CFU/mL. Amongst the 759 presumptive isolates retrieved, sixty-one were confirmed as V. cholerae which were further serogrouped as Non-O1/Non-O139 V. cholerae. Various V. cholerae resistant phenotypes/genoytypes were detected vis: carbapenemase (CR-Vc; 31.1%/5.3%). New Delhi Metallobetalactamase (NDM-1-Vc; 23.0%/42.5%), extended spectrum betalactamase (ESBL-Vc; 42.6%/blaTEM:86,7%), chloramphenicol resistance (62.3%/Flor: 46.2%}, tetracycline resistance (70.5%/46.7%), AmpC resistance (21.0 (34.4%/56.7%)) and various other resistant genotypes/phenotypes. It was observed that more than 50% of the confirmed V. cholerae isolates possess resistance to two or more antibiotic classes/groups with multiple antibiotic resistance index (MARI) ranging from 0.031 to 0.5. This observation provides necessary information and updates for surveillance, planning and implementation of control strategies for cholera. It would also encourage decision making, formulation of policy by the government and cholera control authorities.


Assuntos
Antibacterianos/farmacologia , Cólera/tratamento farmacológico , Cólera/prevenção & controle , Vibrio cholerae/efeitos dos fármacos , Vibrio cholerae/isolamento & purificação , Cólera/epidemiologia , Resistência Microbiana a Medicamentos , Humanos , Controle de Infecções , Testes de Sensibilidade Microbiana/métodos , Reação em Cadeia da Polimerase , Vibrio cholerae/genética , Abastecimento de Água
12.
Eur J Health Econ ; 21(9): 1329-1350, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32789780

RESUMO

Pandemics and major outbreaks have the potential to cause large health losses and major economic costs. To prioritize between preventive and responsive interventions, it is important to understand the costs and health losses interventions may prevent. We review the literature, investigating the type of studies performed, the costs and benefits included, and the methods employed against perceived major outbreak threats. We searched PubMed and SCOPUS for studies concerning the outbreaks of SARS in 2003, H5N1 in 2003, H1N1 in 2009, Cholera in Haiti in 2010, MERS-CoV in 2013, H7N9 in 2013, and Ebola in West-Africa in 2014. We screened titles and abstracts of papers, and subsequently examined remaining full-text papers. Data were extracted according to a pre-constructed protocol. We included 34 studies of which the majority evaluated interventions related to the H1N1 outbreak in a high-income setting. Most interventions concerned pharmaceuticals. Included costs and benefits, as well as the methods applied, varied substantially between studies. Most studies used a short time horizon and did not include future costs and benefits. We found substantial variation in the included elements and methods used. Policymakers need to be aware of this and the bias toward high-income countries and pharmaceutical interventions, which hampers generalizability. More standardization of included elements, methodology, and reporting would improve economic evaluations and their usefulness for policy.


Assuntos
Cólera/epidemiologia , Controle de Doenças Transmissíveis/organização & administração , Epidemias/economia , Viroses/epidemiologia , Cólera/economia , Cólera/terapia , Controle de Doenças Transmissíveis/economia , Análise Custo-Benefício , Humanos , Pandemias , Viroses/economia , Viroses/terapia
13.
PLoS Negl Trop Dis ; 14(8): e0008406, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32776919

RESUMO

We hypothesized that Cholera (Vibrio cholerae) that appeared along Lake Kivu in the African Rift in the seventies, might be controlled by volcano-tectonic activity, which, by increasing surface water and groundwater salinity and temperature, may partly rule the water characteristics of Lake Kivu and promote V. cholerae proliferation. Volcanic activity (assessed weekly by the SO2 flux of Nyiragongo volcano plume over the 2007-2012 period) is highly positively correlated with the water conductivity, salinity and temperature of the Kivu lake. Over the 2007-2012 period, these three parameters were highly positively correlated with the temporal dynamics of cholera cases in the Katana health zone that border the lake. Meteorological variables (air temperature and rainfall), and the other water characteristics (namely pH and dissolved oxygen concentration in lake water) were unrelated to cholera dynamics over the same period. Over the 2016-2018 period, we sampled weekly lake water salinity and conductivity, and twice a month vibrio occurrence in lake water and fish. The abundance of V. cholerae in the lake was positively correlated with lake salinity, temperature, and the number of cholera cases in the population of the Katana health zone. V. cholerae abundance in fishes was positively correlated with V. cholerae abundance in lake water, suggesting that their consumption directly contaminate humans. The activity of the volcano, by controlling the physico-chemical characteristics of Lake Kivu, is therefore a major determinant of the presence of the bacillus in the lake. SO2 fluxes in the volcano plume can be used as a tool to predict epidemic risks.


Assuntos
Cólera/epidemiologia , Lagos/química , Lagos/microbiologia , Erupções Vulcânicas/efeitos adversos , Animais , República Democrática do Congo/epidemiologia , Condutividade Elétrica , Peixes/microbiologia , Humanos , Concentração de Íons de Hidrogênio , Oxigênio/análise , Ruanda , Salinidade , Dióxido de Enxofre/análise , Temperatura , Vibrio , Microbiologia da Água
14.
J Water Health ; 18(4): 494-504, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32833676

RESUMO

Solar disinfection (SODIS) has been shown to reduce the risk associated with the contraction of water borne diseases such as cholera. However, little or no research has been undertaken in exploring the role played by the immune system following the consumption of solar inactivated water pathogens. This study investigated the potential for solar inactivated Vibrio cholerae to induce the maturation of dendritic cells in vitro. Dendritic cells are professional antigen presenting cells found in mammals. However, only in their mature form are dendritic cells able to play their role towards a long lasting immune response. Three strains of V. cholerae were solar irradiated for 7 hours. Thereafter, the solar irradiated, non-solar irradiated, phosphate buffered saline prepared and heat/chemically inactivated cultures of V. cholerae as well as lipopolysaccharide and cholerae toxin-ß subunit were used to stimulate immature dendritic cells. After 48 hours, the dendritic cells were assessed for the expression of CD54, CD80, CD83, CD86, MHC-I and MHC-II cell surface markers. Results show that solar inactivated V. cholerae was able to induce maturation of the dendritic cells in vitro. These findings suggest that there may be an immunological benefit in consuming SODIS treated water.


Assuntos
Cólera , Células Dendríticas , Luz Solar , Vibrio cholerae , Animais , Anticorpos Antibacterianos , Linhagem Celular
15.
J Prev Med Public Health ; 53(4): 289-292, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32752599

RESUMO

Yemen has been faced with the worst cholera epidemic of modern times, with more than 1 million suspected cases and 3000 deaths at the time of writing. This problem is largely due to the longstanding civil war between pro-government forces and the Houthi armed movement, which has severely damaged already vulnerable sanitation and healthcare facilities and systems in the country. It is further compounded by a dire lack of basic amenities, chronic malnutrition, and unfavourable weather conditions. Another contributory component may be aerial transfer by cholera-infected chironomid insects. To contain the spread of cholera in Yemen, a nation-wide armistice should be negotiated, and national and local committees must be convened to coordinate efforts on the ground. Community isolation facilities with proper sanitation, reliable disposal systems, and a clean water supply should be set up to isolate and treat sick patients. The continuity of vaccination programmes should be ensured. Public health campaigns to educate local communities about good hygiene practices and nutrition are also necessary. The One Health paradigm emphasizes a multi-sectoral and transdisciplinary understanding and approach to prevent and mitigate the threat of communicable diseases. This paradigm is highly applicable to the ongoing cholera crisis in Yemen, as it demands a holistic and whole-of-society approach at the local, regional, and national levels. The key stakeholders and warring parties in Yemen must work towards a lasting ceasefire during these trying times, especially given the extra burden from the mounting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak worldwide.


Assuntos
Cólera/prevenção & controle , Epidemias , Educação em Saúde/métodos , Saúde Única , Saúde Pública/métodos , Cólera/diagnóstico , Cólera/terapia , Humanos , Iêmen
17.
PLoS Negl Trop Dis ; 14(7): e0008045, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32663235

RESUMO

After being cholera free for over 100 years, Peru experienced an unprecedented epidemic of Vibrio cholerae O1 that began in 1991 and generated multiple waves of disease over several years. We developed a mechanistic transmission model that accounts for seasonal variation in temperature to estimate spatial variability in the basic reproduction number ([Formula: see text]), the initial concentration of vibrios in the environment, and cholera reporting rates. From 1991-1997, cholera spread following a multi-wave pattern, with weekly incidence concentrated during warm seasons. The epidemic first hit the coastal departments of Peru and subsequently spread through the highlands and jungle regions. The correlation between model predictions and observations was high (range in R2: 58% to 97%). Department-level population size and elevation explained significant variation in spatial-temporal transmission patterns. The overall R0 across departments was estimated at 2.1 (95% CI: 0.8,7.3), high enough for sustained transmission. Geographic-region level [Formula: see text] varied substantially from 2.4 (95% CI: 1.1, 7.3) for the coastal region, 1.9 (0.7, 6.4) for the jungle region, and 1.5 (0.9, 2.2) for the highlands region. At the department level, mean [Formula: see text] ranged from 0.8 to 6.9. Department-level [Formula: see text] were correlated with overall observed attack rates (Spearman ρ = 0.59, P = 0.002), elevation (ρ = -0.4, P = 0.04), and longitude (ρ = -0.6, P = 0.004). We find that both [Formula: see text] and the initial concentration of vibrios were higher in coastal departments than other departments. Reporting rates were low, consistent with a substantial fraction of asymptomatic or mild cases associated with the El Tor cholera biotype. Our results suggest that cholera vibrios, autochthonous to plankton in the natural aquatic environment, may have triggered outbreaks in multiple coastal locations along the Pacific coast of Peru. Our methodology could be useful to investigate multi-wave epidemics of cholera and could be extended to conduct near real-time forecasts and investigate the impact of vaccination strategies.


Assuntos
Cólera/epidemiologia , Número Básico de Reprodução , Cólera/microbiologia , Clima , Epidemias , Humanos , Peru/epidemiologia , Estações do Ano , Vibrio cholerae O1/fisiologia
18.
Epidemiol Infect ; 148: e186, 2020 07 08.
Artigo em Inglês | MEDLINE | ID: mdl-32635946

RESUMO

In mainland China, the clinical, epidemiological and genetic features of non-O1/non-O139 Vibrio cholerae (NOVC) bacteraemia have been scarcely investigated. Herein, we describe a patient with NOVC bacteraemia diagnosed in our hospital and present a retrospective analysis of literature reports of 32 other cases in China, detailing the clinical epidemiology, antibiotic resistance and molecular characteristics of isolates. Most patients were male (84.8%; median age, 53 years) and had predisposing factors, such as cirrhosis, malignant tumours, blood diseases and diabetes. In addition to fever, gastroenteritis was the most frequent presenting symptom. The mortality rate during hospitalisation was 12.1%. NOVC bacteraemia cases were more common in June-August, with the majority in coastal provinces and the Yangtze River basin. Only 42.4% of cases were attributed to consumption of marine (aquatic) products. Tetracycline, third-generation cephalosporins, and fluoroquinolones were the most effective antimicrobial agents, and the highest frequencies of resistance were recorded for ampicillin/sulbactam (37.5%), amoxicillin/clavulanic acid (33.3%), ampicillin (29.2%) and sulfamethoxazole (20%). Multi-drug resistant isolates were not detected. Limited data indicate that ctxAB and tcpA genes were absent in all NOVC isolates but other putative virulence genes (hlyA, toxR, hap and rtxA) were common. Ten multilocus sequence types were identified with marked genetic heterogeneity between different isolates. As clinical manifestations of NOVC bacteraemia may vary widely, and isolates exhibit genetic diversity, clinicians and public health experts should be alerted to the possibility of infection with this pathogen because of the high prevalence of liver disease in China.


Assuntos
Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Cólera/sangue , Cólera/complicações , Vibrio cholerae , Idoso , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , China/epidemiologia , Cólera/tratamento farmacológico , Cólera/epidemiologia , Humanos , Masculino
19.
PLoS One ; 15(7): e0235440, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32614915

RESUMO

BACKGROUND: Cholera remains a significant public health problem in more than one-third of the countries of the world. Cholera outbreak has become more common in Addis Ababa particularly in the rainy seasons; however, there is a paucity of data on risk factors associated with cholera outbreaks rendering interventions difficult. We investigated the outbreak to identify its etiology, source, risk factors and in order to control the outbreak. METHODS: We compared cases with health center-based unmatched controls (1:2). Cases were patients aged ≥5 years with acute watery diarrhea, with or without vomiting while controls were persons aged ≥5 years without history of acute watery diarrhea. We interviewed our study participants using structured questionnaire to collect demographic and cholera risk factors data. We described the outbreak over time, and then tested our hypotheses using unconditional logistic regression. RESULTS: The outbreak began on 7 September, 2017 reaching its peak on 23 September, 2017 and ended on 01 October, 2017. We identified a total of 25 cases (Median age: 38 years; IQR: 20 years) and recruited 50 controls (Median age: 35 years; IQR: 29 years). All case-patients had acute watery diarrhea and dehydration requiring intravenous fluids. All cases were admitted to cholera treatment center but there were no deaths. Stool and water samples yielded isolates of Vibrio cholerae O1 of serological subtype Ogawa. Consumption of contaminated holy water (AOR: 20.5, 95%CI: 3.50, 119.61) and raw vegetables (AOR: 15.3, 95%CI: 3, 81.51) were independent risk factors whereas washing hands with soap after visiting latrine (AOR: 0.04, 95%CI: 0.01, 0.25) was independent protective factor. CONCLUSION: Our findings demonstrated cholera foodborne transmission via consumption of raw vegetables, and its waterborne transmission via consumption of contaminated holy water. Washing hands with soap after visiting latrine was protective. We recommended cooking of vegetables and promoting hand washing.


Assuntos
Cólera/epidemiologia , Surtos de Doenças , Doenças Transmitidas por Alimentos/epidemiologia , Vibrio cholerae O1/isolamento & purificação , Estudos de Casos e Controles , Diarreia/epidemiologia , Diarreia/microbiologia , Água Potável/microbiologia , Etiópia , Fezes/microbiologia , Microbiologia de Alimentos , Desinfecção das Mãos , Fatores de Risco , Inquéritos e Questionários , Toaletes , Verduras/microbiologia , Verduras/envenenamento , Vômito/epidemiologia , Microbiologia da Água
20.
PLoS One ; 15(7): e0236016, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32649692

RESUMO

Cholera remains a major global public health threat and continuous emergence of new Vibrio cholerae strains is of major concern. We conducted a molecular epidemiological study to detect virulence markers and antimicrobial resistance patterns of V. cholerae isolates obtained from the 2012-2015 cholera outbreaks in Ghana. Archived clinical isolates obtained from the 2012, 2014 and 2015 cholera outbreaks in Ghana were revived by culture and subjected to microscopy, biochemical identification, serotyping, antibiotic susceptibility testing, molecular detection of distinct virulence factors and Multi-Locus Variable-Number of Tandem-Repeat Analysis (MLVA). Of 277 isolates analysed, 168 (60.6%) were confirmed to be V. cholerae and 109 (39.4%) isolates constituted other bacteria (Escherichia coli, Aeromonas sobria, Pseudomonas aeruginosa, Enterobacter cloacae and Enterococci faecalis). Serotyping the V. cholerae isolates identified 151 (89.9%) as Ogawa, 3 (1.8%) as Inaba and 14 (8.3%) as non-O1/O139 serogroup. The O1 serogroup isolates (154/168, 91.7%) carried the cholera toxin ctxB gene as detected by PCR. Additional virulence genes detected include zot, tcpA, ace, rtxC, toxR, rtxA, tcpP, hlyA and tagA. The most common and rare virulence factors detected among the isolates were rtxC (165 isolates) and tcpP (50 isolates) respectively. All isolates from 2014 and 2015 were multidrug resistant against the selected antibiotics. MLVA differentiated the isolates into 2 large unique clones A and B, with each predominating in a particular year. Spatial analysis showed clustering of most isolates at Ablekuma sub-district. Identification of several virulence genes among the two different genotypes of V. cholerae isolates and resistance to first- and second-line antibiotics, calls for scaleup of preventive strategies to reduce transmission, and strengthening of public health laboratories for rapid antimicrobial susceptibility testing to guide accurate treatment. Our findings support the current WHO licensed cholera vaccines which include both O1 Inaba and Ogawa serotypes.


Assuntos
Cólera/epidemiologia , Vibrio cholerae/metabolismo , Antibacterianos/farmacologia , Cólera/diagnóstico , Cólera/microbiologia , Toxina da Cólera/genética , Toxina da Cólera/metabolismo , Surtos de Doenças , Farmacorresistência Bacteriana Múltipla/genética , Gana/epidemiologia , Humanos , Testes de Sensibilidade Microbiana , Filogenia , Sorogrupo , Sequências de Repetição em Tandem/genética , Vibrio cholerae/classificação , Vibrio cholerae/isolamento & purificação , Vibrio cholerae/patogenicidade , Virulência/genética
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